Biventricular pulsus alternans
Pulsus alternans is alternating volume of pulse, with a regular rhythm, mostly seen with severe left ventricular dysfunction. Biventricular and right ventricular pulsus alternans needs cardiac catheterization or Doppler echocardiography to demonstrate the alternating right ventricular or pulmonary artery systolic pressures. Biventricular pulsus alternans is much rarer than left ventricular pulsus alternans. One case reported was biventricular pulsus alternans due to anterior wall myocardial infarction [1]. Another report was an echocardiographic demonstration of biventricular pulsus alternans by echocardiography in a cas...
Source: Cardiophile MD - December 18, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Right ventricular pulsus alternans
can be isolated or associated with left ventricular pulsus alternans. Right ventricular and pulmonary artery pulsus alternans are demonstrated by cardiac catheterization studies. In one case of right ventricular pulsus alternans due to right ventricular infarction, improvement was obtained by coronary sinus pacing [1].
Doppler alternans and murmur alternans corresponding to right ventricular pulsus alternans has been noted in critical pulmonary stenosis with right ventricular dysfunction [2]. Pulmonary embolism and pulmonary hypertension [3] are other situations in which right sided pulsus alternans can be observed.
A rar...
Source: Cardiophile MD - December 18, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Right sided Austin Flint murmur
Brief Review
Classical Austin Flint murmur is a mid diastolic murmur in the mitral area heard in those with free aortic regurgitation. By similar analogy, a mid diastolic murmur in pulmonary regurgitation can be called a right sided Austin Flint murmur. Mid diastolic and presystolic murmurs could be demonstrated in 7 out of 14 cases of pulmonary regurgitation in an old study by cardiac catheterization and phonocardiography [1]. All these patients had pulmonary hypertension. The right sided Austin Flint murmur was thought to be due to functional tricuspid stenosis caused by the pulmonary regurgitation. The antegrade flow t...
Source: Cardiophile MD - December 11, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Trans Esophageal Echocardiography (TEE)
Transesophageal echocardiography is a specialised form of echocardiographic study using an echo probe held at the tip of an endoscope like device. As the esophagus is very close to the heart, higher quality images are obtained. Interference by air in the lungs, which is usual for transthoracic echocardiography (TTE) is also avoided. As the imaging is in the near field, higher frequency transducers can be used, providing better image resolution. TEE imaging frequency is of the order of 5 – 10 MHz. TEE is very useful for imaging the posterior structures of the heart like the left atrium. Clots in the left atrial app...
Source: Cardiophile MD - December 6, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Echocardiography Intra operative TEE Intra operative trans esophageal echocardiography risk of TEE risk of trans esophageal echocardiography TEE for liver transplantation surgery TEE in those with esophageal varices Transesophageal echocardi Source Type: blogs
Left Bundle Branch Block (LBBB) and STEMI criteria
Left bundle branch block is manifested on the ECG with wide QRS with deep slurred QS complex in V1 and slurred R wave in V6. ST segment and T wave vectors are discordant to the QRS vector, meaning that when the QRS positive as in V6, the ST segment will be depressed and T wave will be inverted. This is known as secondary ST – T abnormality. If the ST segment and T wave are concordant to the QRS, it indicates a primary myocardial abnormality. An elevated ST segment and an upright T wave in V6 with a positive QRS is taken as an evidence of myocardial infarction / ischemia in the presence of left bundle branch block (LB...
Source: Cardiophile MD - December 5, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology Selvester 10% RS criteria Sgarbossa criteria Smith 25% S-wave criteria Source Type: blogs
Cyanotic spell
Brief Review
Cyanotic spells are episodes of worsening of cyanosis (also called hypercyanotic spells, Tet spell for short [1]) in infants with cyanotic congenital heart disease with low pulmonary blood flow (Tetralogy of Fallot physiology). Tet spells can also rarely occur in adults with Tetralogy of Fallot [1]. Cyanotic spells are associated with hyperpnea and may lead to loss of consciousness and even hypoxic seizures if the episodes are prolonged. They can be precipitated by crying or other forms of exertion.
A rare instance of refractory cyanotic spell in a patient with Tetralogy of Fallot due to thrombus in right ve...
Source: Cardiophile MD - November 26, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Cyanotic spells in D-TGA with LVOT obstruction Tet spell Tetralogy of Fallot Source Type: blogs
Chest Pain, ST Elevation, and an Elevated Troponin: Should we Activate the Cath Lab?
This was written by Sam Ghali (@EM_RESUS), with a few edits by me. 52-year-old lady presents to the Emergency Department with 2 hours of chest pain, palpitations & SOB. She is somewhat hypertensive, but her vital signs are otherwise normal. Here is her 12-Lead ECG: There’s a sinus rhythm at around 70 bpm. There are Q-waves in the inferior leads (II, III, & AVF) with ST-Elevations. These elevations meet STEMI criteria (≥1mm in 2 contiguous leads). However, old MI w/aneurysm morphology (persistent ST-Elevation) can look just like this. Looking closer, we see clear ST depression in the lateral l...
Source: Dr. Smith's ECG Blog - November 26, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Research and Reviews in the Fastlane 110
Welcome to the 110th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.
This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check ou...
Source: Life in the Fast Lane - November 25, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Emergency Medicine Haematology Infectious Disease Intensive Care LITFL review Pediatrics Resuscitation Toxicology and Toxinology critical care Education literature R&R in the FASTLANE recommendations Research and Review Source Type: blogs
Technology in health care requires context
Robert was the picture of health. He had run eight marathons and finished countless 5K and 10K races. He tracked everything from sleep to food intake, logging his exercise parameters religiously.
A seven-minute mile was a routine workout for Robert. But over the course of a few days, he noticed that he felt more winded during his run. One morning, when he awoke and checked his heart rate variability (HRV), it revealed a unusual drop. His VO2 max had also fallen considerably. So Robert sent an email to his physician, sharing his data and concerns. His doctor was also a runner, and loved when his patients armed him with dat...
Source: Kevin, M.D. - Medical Weblog - November 15, 2015 Category: Journals (General) Authors: Howard Luks, MD Tags: Tech Heart Orthopedics Source Type: blogs
Waiting For ISCHEMIA: Why Won’t Cardiologists Enroll Patients?
One of the most important unanswered questions in medicine today– the best treatment for stable ischemic heart disease– may never get a satisfactory answer because cardiologists are unwilling to enter their patients in a clinical trial. One major reason why the question is urgent: about a third of the 1 million PCI procedures performed each year in the...Click here to continue reading... (Source: CardioBrief)
Source: CardioBrief - November 8, 2015 Category: Cardiology Authors: Larry Husten Tags: Uncategorized catheterization COURAGE ischemia NIH optimal medical therapy PCI Source Type: blogs
5 ways radiologists can reduce unnecessary tests
The Lown Institute advocates rational use of medical resources. This is a noble goal and worthy of the attention of radiologists. It was recently RightCare Action Week: Here are five simple things any radiologist can do that week, and the following weeks. This will improve patient care by avoiding unnecessary tests.
1. Speak to the referring clinician, at least sometimes, if not often, perhaps twice a day. The conversation need not be adversarial. Ask before the imaging two simple questions. What will you do if the test is positive? What will you do if the test is negative? Inquire four weeks after the imaging is done i...
Source: Kevin, M.D. - Medical Weblog - November 3, 2015 Category: Journals (General) Authors: Dr. Saurabh Jha Tags: Physician Radiology Source Type: blogs
Right Care Action Week – What can Radiologists do?
By SAURABH JHA, MD
The Lown Institute advocates rational use of medical resources. This is a noble goal and worthy of the attention of radiologists. This week is the right care action week. Here are five simple things any radiologist can do this week, and the following weeks. This will improve patient care by avoiding unnecessary tests.
Speak to the referring clinician, at least sometimes, if not often, perhaps twice a day. The conversation need not be adversarial. Ask before the imaging two simple questions. What will you do if the test is positive? What will you do if the test is negative? Inquire four weeks after the im...
Source: The Health Care Blog - October 20, 2015 Category: Consumer Health News Authors: Simon Nath Tags: THCB Saurabh Jha Source Type: blogs
This is what patient-centered family medicine looks like
I want to share a recent anecdote from my clinic that highlights how patient-centered family medicine is cost effective and simply good care for patients.
I saw Mr. F, a 75-year-old gentleman. Like many of my patients, he has a history of high blood pressure and obesity. He also had a heart attack in the past as well as two additional stents placed in his coronary arteries. I was seeing him in follow-up to his hospitalization. Given the patient-centered medical home (PCMH) model that Kaiser Permanente uses, I could easily pull up all the labs and notes from his hospitalization, as well as his cardiac catheterizatio...
Source: Kevin, M.D. - Medical Weblog - October 9, 2015 Category: Journals (General) Authors: Alex Mroszczyk-McDonald, MD Tags: Physician Primary care Source Type: blogs
The story of the brave doctor who jammed a catheter in his heart
Meet the courageous doctor who shoved a catheter all the way up his arm and into his own heart to prove that cardiac catheterization in a live human being was possible. Produced by Fusion.
Continue reading ...
Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - October 2, 2015 Category: Journals (General) Authors: Admin Tags: Video Heart Source Type: blogs
Is this STEMI? No, it is one of the most common reasons for false cath lab activation.
This was contributed by Brooks Walsh, with a little editing and additions, plus a section of false positive cath lab activations added by me. Brooks is a fine emergency physician from the Yale residency who has a keen and talented interest in ECGs and bedside cardiac echo.CaseA middle-aged man was sent to the ED from a primary care clinic, with “ECG changes” and worry for STEMI.The ECG shows ST elevation (STE) across the precordium, highest in V2 and V3. There are only minimal R waves in those leads [in fact, such tiny R-waves are technically considered Q-waves, and thus the patient has "QS"-waves (deep Q-waves w...
Source: Dr. Smith's ECG Blog - September 22, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
